2.4 Multiple factors involved in traffic crashesRTCs are usually consequences of multiple factors [49]. Two studies, conductedin<strong>de</strong>pen<strong>de</strong>ntly in the United States and Great Britain, showed that although road user-relatedfactors were i<strong>de</strong>ntified in up to 94% of RTCs, other factors were also involved in a third ofthem (Figure 3) [55]. In most cases, such crashes resulted when both road user- and roadsituational factors (indicated in red) were involved. These situational factors can be fixed roa<strong>de</strong>nvironmental characteristics, such as road geometry, or transient environmentalcircumstances, such as weather, light, or traffic conditions [55]. Current evi<strong>de</strong>nce alsosuggests that interventions on road environment-related factors can prevent driver-relate<strong>de</strong>rrors and violations, the foremost cause of traffic crashes reported elsewhere [58]. In thisregard, the two known approaches are to make roads “self-explaining” and “forgiving” [3].For instance, speeding is clearly facilitated by plain road profile and installation of speedcalmingmeasures in such situations <strong>de</strong>creases crash likelihood by indirectly influencingdrivers to reduce their speeds (self-explaining roads) [11]. Further, installation of impactabsorbing barriers would mitigate the severity of crash if the crash occurs at all (forgivingroads) [14].Figure 3. Contribution of risk factors in road traffic crashes (adapted from [55])Great BritainUnited States of AmericaRoad an<strong>de</strong>nvironment28%Vehicle8%Road an<strong>de</strong>nvironment34%Vehicle12%2 123 12241427366567Road User94%Road user93%2.5 Implications of interactions for highway safetyHighways are the backbone of the economy in all countries. In absence of effective railwaysand motorways, mixed dual- and single-roads are the major link for almost all transportationof consumables from farms to markets [6]. These roads are over-involved in crash fatalities.For instance in the United States of America (USA), 54% of traffic fatalities occur on suchtype of road sections [59], similarly, interurban road sections in France account for one thirdof road crashes but two thirds of road fatalities (Table 2) [9]. Undoubtedly, severity of trafficcrashes on these roads is higher than those on urban roads. The key <strong>de</strong>terminant of the highcrash fatality is travel speed, itself allowed on these road types [19, 24]. Relationship between16
oad situational factors, high speed, and crash locations has also been <strong>de</strong>monstrated on ruralroads in HICs [60].Table 2. Traffic fatalities according to road network type in France, 2004Road network Injury crashes Deaths Crash severity*Urban roads 57 825 1 451 2.5Rural roads 27 565 3 781 13.7Motorways 8 182 584 7.1National roads 5 436 951 17.5District roads 13 947 2 246 16.1* Fatality per crash × 100Traffic prevention on these road sections implies preventing risky road behaviours [61]. Road<strong>de</strong>sign, surface, markings, furniture, and traffic management play an important role inreducing crash likelihood by reducing the inappropriate road user behaviours on these roadsections [60]. Previous research in <strong>de</strong>veloped countries has clearly <strong>de</strong>monstrated thatengineering measures were highly cost effective in reducing injury crashes compared to thosetargeting only road behaviours or vehicle factors [49]. A British study showed that completeupgrading of national highways to motorways reduced crashes by 76% and traffic fatalities by81% [62]. Similarly, installation of wired guardrail reduced the likelihood of head-on crasheson undivi<strong>de</strong>d rural road sections in Swe<strong>de</strong>n [14]. However, <strong>de</strong>velopment of these measuresrequires rigorous research methods to assess their appropriateness to local traffic conditionsand <strong>de</strong>mands [14, 16].2.6 Factors limiting implementation of engineering measures in LMICsHighway traffic safety has not received appropriate attention in LMICs, both in terms ofestimating the injury bur<strong>de</strong>n and assessing risk factors [11]. Some of the few studiesconducted in such settings suggest that these road sections are important concentrations oftraffic crashes in LMICs, probably due to over-involvement of vulnerable road users [17, 19,63]. Although there is evi<strong>de</strong>nce of an increasing injury bur<strong>de</strong>n, adaptation and implementationof proven engineering interventions in LMICs is impe<strong>de</strong>d by major knowledge gaps [50]:Firstly, reporting of injuries and availability of RTC and RTI data remains in general the mostimportant difficulty in LMICs. A study in Pakistan showed that police statistics accounts foronly 56% of traffic fatalities and 4% of severe injuries in urban settings [64]. Similar resultswere observed in Iran where the official data source for traffic fatalities was compared withhealth facility data [65]. As most LMICs do not have vital registration data, WHO recentlyestimated traffic fatalities in those countries while including information on traffic exposure,risk, preventive, and mitigating factors in their mo<strong>de</strong>l [2]. The results showed that in mosthighly populated LMICs, official statistics inclu<strong>de</strong>d only half or less of the actual trafficfatalities occurred in those countries (Figure 4). Thus, without proper estimates, it becomesvery difficult to advocate for preventive measures in these countries [50].17
- Page 1: Université Victor Segalen Bordeaux
- Page 4 and 5: Publications (peer-reviewed).......
- Page 6 and 7: Index of figuresFigure 1. Traffic f
- Page 8 and 9: AbbreviationsAKUAVCIBMIEASESSDALYDW
- Page 10 and 11: AbstractBackground: Interurban traf
- Page 12 and 13: L'objectif de cette thèse était d
- Page 14 and 15: 2. Background2.1 Road injury burden
- Page 18 and 19: Figure 4. Percentage difference of
- Page 20 and 21: 2.7 Interurban road safety research
- Page 22 and 23: ObjectivesThe objectives of this fi
- Page 24 and 25: ResultsCrash burdenA total of 935 R
- Page 26 and 27: Figure 7. Monthly trend of traffic
- Page 28 and 29: Injury outcome patternsMost of inju
- Page 30 and 31: MethodsThe study setting was 196-km
- Page 32 and 33: patients. In the ED, those with NIS
- Page 34 and 35: Table 6. Traffic injuries reported
- Page 36 and 37: 5. Analytical StudiesPrevious liter
- Page 38 and 39: under supervision of Dr. Sobngwi-Ta
- Page 40 and 41: Table 9. Situational variables at c
- Page 42 and 43: MethodsStudy design and settingStud
- Page 44 and 45: to Dec 08 were retrieved and photoc
- Page 46 and 47: normal zones. However, this associa
- Page 48 and 49: MethodsStudy design and settingsThe
- Page 50 and 51: Figure 14. Picture extracted of a h
- Page 52 and 53: located in built-up area in Pakista
- Page 54 and 55: Table 15. Differences in hazard per
- Page 56 and 57: 6. Discussion6.1 Originality of stu
- Page 58 and 59: Although adjustments are possible,
- Page 60 and 61: observational studies on how the de
- Page 62 and 63: to understand the deficiencies in t
- Page 64 and 65: [24] Damsere-Derry J, Afukaar FK, D
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[69] Central Intelligence Agency. T
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[111] Geurts K, Wets G, Brijs T, Va
- Page 70 and 71:
[154] Rosenbloom T, Shahar A, Elhar
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4. Farooq U, Bhatti JA, Siddiq M, M
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Appendix 1: Literature review on in
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they identified a cluster of long b
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more cost-effective than redesignin
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Table 18. Traffic injury interventi
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Appendix 3: Study I supplementary r
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Appendix 4: Manuscript in preparati
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BACKGROUNDPakistan, located at the
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patients were recorded during their
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This might motivate police officers
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12. Peden M, Scurfiled R, Sleet D,
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Table 1. Traffic injuries reported
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Table 3. Ascertainment of police, a
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Appendix 5: Article published - Stu
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104
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106
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108
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Appendix 6: Article under review -
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1. INTRODUCTIONWith the aging of hi
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A total of 180 crashes were identif
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conspicuity at HWZs in Pakistan. 2
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21. Sobngwi-Tambekou J, Bhatti J, K
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Table 2. Highway work zone crash fa
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122
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ABSTRACTObjectives: Interurban road
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oad). A matched strategy was used t
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SitesOut of 131 crash sites identif
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Similarly, it was shown previously
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Majdzadeh, R., Khalagi, K., Naraghi
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Table 2. Characteristics of Pakista
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Table 4. Factors associated with ha
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Table 21. Situational factors at hi
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Table 23. Situational factors assoc